Hernia Surgery & Treatment in Thailand - Samitivej Hospitals

Simply put, it is a defect in the abdominal wall. A normal abdominal wall is composed of muscles and fascia, but when there is neither muscle nor fascia, there is a hole. This allows for the intestine or abdominal organ to protrude through.

Hernia is usually caused by abdominal strain overtime or the weak area that may exist since birth. Although it usually occurs in the abdomen between the chest and hips, it can also appear in the upper thigh and groin areas. If not treated, hernias can worsen over time.

There are several types depending on their location.

Inguinal or Groin hernia

Inguinal hernias are the most common type, especially in men. They are located in the inguinal canal found in the groin and appears when the intestines push through a weak or tear in the abdominal wall. In men, it is found around the spermatic cord which holds the testicles. Whereas, in women, the inguinal canal contains a ligament that holds the uterus. An inguinal hernia occurs more commonly in men because the testicles fall towards the inguinal canal soon after birth. When the canal does not close as it should, it leaves a weakened area.

Umbilical hernia

Umbilical hernia is an abnormal lump near the belly button. Even though it is more common in children, it can occur during adulthood as well. In children, this type of hernia goes away on its own as the abdominal walls get stronger. For more information on childhood Hernias treatment, please click here

Contrarily, in adults, an umbilical hernia can ensue from repeated strain on the abdomen mostly due to intense exercise, constipation, chronic coughing, pregnancy or obesity. More common in men, it can affect anyone in any age group and requires treatment.

Ventral hernia

It results from a weak area in the abdomen that allows for the tissues to bulge through an opening in the muscles. It is usually acquired during one’s lifetime, but can also be present from birth. Excessive activity, obesity, and pregnancy are common factors of ventral hernia formation. Surgery can also cause a ventral hernia which is then referred to as an incisional hernia.

Incisional hernias

There is a 15 to 20% chance of incisional hernias happening as a result of abdominal operations involving incisions. Like the name suggests, its a lump near the incision site.

• The most common symptom is a lump where the hernia is located. It can start small and gradually grow. The lumps tend to become prominent when straining or putting weight on the abdomen.
• Patient may feel discomfort or tenderness in the affected area, especially if it close to the nerve.
• Pain felt during exercise or certain activities like coughing, standing up or bending down. The level of pain varies depending on the size and location of the hernia.
• The least common symptom would be nausea or vomiting. It’s important to note, though, that in many cases hernias may be asymptomatic. This means it may only show up in routine physical or medical check-ups.

It is best to consult a specialist if you experience any discomfort or pain. In the case where there were no symptoms, and the hernia is left untreated, the bowel could get stuck in the hole. This causes incarceration or strangulation which may lead to severe pain, requiring immediate medical attention.

Incarceration is when the intestine becomes trapped in a weak abdomen wall and cannot be pushed back. Strangulation is when there is swelling, creating a blockage of blood flow to the intestine.

Don't leave the hernia untreated until it you experience severe pain. Click here to make an appointment with doctor if you notice any symptoms.

Firstly, your doctor will perform a physical examination. If the hernia is obvious, then the doctor can see a bulge that goes away when the patient lies down. Then, the doctor will ask about your medical history as well as your lifestyle, including your exercise routine, and if you smoke. Your risks also depend on if you have had abdomen or groin surgery in the past, and your family history of hernias. In the case that the hernia isn’t prominent, your doctor will carry out an imaging test of either an abdominal ultrasound, CT scan, or MRI scan. This will aid the doctor with the diagnosis.

Inguinal, Umbilical, Ventral, and all other types of hernias including the lesser common ones can be repaired with an open surgery or a laparoscopic surgery. There are pros and cons to each treatment method, which may differ from case to case. Our doctor will share the details of which the patient, so they can make a well-informed choice for treatment.

We can keep the hernia in place with non-surgical approaches using a corset, truss, or binder to apply gentle pressure, and prevent future complications. Even then, the possibility remains, so it important to monitor the hernia.

The only effective way to cure a hernia is through a surgical repair, the purpose of which is to close the hole. It is important to choose a trusted and experienced general or laparoscopic surgeon and a medical facility well-equipped for these procedures.

Open surgery

Traditionally, tissue repair or just a stitch was used to keep the muscles together but this caused pain and the recurrent rate was approximately 5%. In the modern technique, we use a mesh or synthetic material to keep the hernia in place until it heals. The new tissue will incorporate the mesh to fix it with the muscle, allowing the mesh to prevent any protruding. Doctors have used mesh in hernia repair for over 2 decades, and the recurrent rate has been less than 1%.

Laparoscopic Surgery

Mesh was first introduced for open surgeries, but it is now also used in the newer technique, the laparoscopic or keyhole surgery. Here, the surgeon makes multiple small openings and fixes the hernia by inserting a small camera inside the body for location guidance. A larger mesh can be used for this procedure, making the hold stronger. Laparoscopic repair is a minimally invasive surgery, hence less painful.

In Samitivej, we use a 3D camera, allowing us to see in more detail and achieve superior results. To secure the mesh we use an absorbable tacker to lessen the chance of complications. Previously, metallic tackers were used, and in some medical facilities, it still is. Strangulate hernia that was once considered a complicated case, can now be treated by laparoscopic surgery with same success rate as other hernias.

Hernia treatments with an open surgery have a 95% success rate, while our laparoscopic surgery using 3D camera and mesh has 99%, with a recurrent rate of less than 1%.

We use biocompatible mesh reducing the chances of an allergic reaction significantly. Although hernia treatments are relatively safe, no surgery is risk-free. The open technique may result in pain around the nerves in less than 5% of cases. However, with laparoscopic repair, we can place the mesh away from the nerve, resulting in lesser risks.

The first two months is the healing period. During this time the tissue will grow and incorporate the mesh to fix the muscles, so it is best to avoid abdominal exercise or weight lifting to allow for complete healing. Basically, steer clear of any activity that puts pressure on the area or it could result in mesh displacement. Taking 1 week off of school or work is recommended.

 Additionally, patients should

• Treat associated risk factors like constipation to avoid straining while having a bowel movement
• Heal aggravating conditions like a chronic cough that may result from allergies or smoking
• Maintain healthy body weight with high-fiber foods and moderate exercises

• The patient will be admitted for 1-2 nights for treatment but can expect to be able to walk 2-3 hours after the surgery with minimal pain.
• Preoperative preparation includes blood work, medical evaluation, chest x-ray, and an EKG, which may vary depending on age and condition
• In case of constipation, the doctor may give an enema or a similar solution
• Do not eat or drink 6 hours before the operation
• Stop certain drugs such as aspirin, anticoagulant medications, and Vitamin E for several days to a week prior to surgery

• Online Consultation: Patients can consult a specialist doctor by submitting a medical report and participating in a video call regarding treatment plans via Samitivej Virtual Hospital.
• Covid-19 Screening: We screen all patients for COVID-19 prior to surgery, to ensure utmost safety for our patients and staff. The screening is provided for free until March 31st, 2021.
• Hygiene and Safety: Other that the disinfectant technologies installed and safety measures taken throughout the hospital, our operating rooms have received international accreditation for the inclusion of laminar airflow filtration devices that reduce the risk of infection. Our bacteria prevention walls and a specially designed glass-wall system reduces bacteria and the chance of infection significantly. Samitivej PROMPT: This service is provided to patients to send a message to their doctor and choose the times of day during in which they do not wish to be disturbed. It also displays initial hospital bill.
• Samitivej PACE: The access link to this application will be sent to patients so they can forward it to their relatives to use for real-time monitoring during surgery. They can check the patient’s status at any time, for instance, while they are waiting to enter the operating room or patient recovery rooms.

• Samitivej PROMPT: This service is provided to patients to send a message to their doctor and choose the times of day during in which they do not wish to be disturbed. It also displays initial hospital bill.
• Online Follow-up Appointment: Patients may change their on-site follow-up appointment to a video call at the discretion of the doctor in charge of treatment.

During this Covid-19 era, a 15-day Alternative Hospital Quarantine (AHQ) is required by the Thai government, before treatment can begin. After that, two days will be needed for treatment. It is advisable to stay one-week post-surgery, for a follow-up before flying back to your home country or you can opt for an online follow-up appointment via Samitivej Virtual Hospital, if your condition allows. In total, we recommend planning a stay in Thailand for a minimum of 3 and a half weeks.

Pakpong Wathanaoran, M.D.

Pakpong Wathanaoran, M.D. is a surgeon at Samitivej Sukhumvit Hospital with over 10 years experience in hernia repair, laparoscopic and abdominal surgeries. He has treated over 500 patients with hernia. Even with such experience, Dr. Pakpong continues to invest time in medical academia by participating in workshops and seminars such as ‘The 2nd Phuket International Symposium in Colorectal Disease, Bangkok Hospital Phuket’ and ‘D2 Gastrectomy, Upper GI Surgery Society of Thailand, Faculty of Medicine Siriraj Hospital’, amongst many others to stay up to date with the latest innovations in the field. To schedule an appointment with Dr. Pakpong, CLICK HERE

You can now consult with our doctor online via Samitivej Virtual Hospital before coming to the hospital. Click here to arrange VDO call with a doctor (subject to availability).

Samitivej has a team ready to help and provide services for: 

• Treatment Plan Consultation with a doctor via online video-call (second opinion)
• Treatment Planning if you have medical records or a price estimate from another hospital 
• Cost Planning by our Appraisals Team with price guarantee (only for procedure packages without complications)
• Check Initial Coverage Eligibility with Thai and international insurance companies (only for insurance companies in contract with the Hospital)